Provider Demographics
NPI:1033185939
Name:ORTHOPAEDIC FELLOWSHIP GROUP LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC FELLOWSHIP GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-874-4600
Mailing Address - Street 1:2901 S.W. 149TH AVE.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4153
Mailing Address - Country:US
Mailing Address - Phone:954-874-4600
Mailing Address - Fax:786-594-5200
Practice Address - Street 1:3399 NW 72ND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1349
Practice Address - Country:US
Practice Address - Phone:954-874-4615
Practice Address - Fax:954-874-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7853Medicare PIN